Affiliation:
1. Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada
2. Canadian Centre for Health Economics, Toronto, ON, Canada
3. Center for Demography of Health and Aging, University of Wisconsin–Madison, Madison, WI, USA
Abstract
Background. Global climate change is resulting in dramatic increases in wildfires. Individuals exposed to wildfires experience a high burden of posttraumatic stress disorder (PTSD), and the cost-effectiveness of the treatment options to address PTSD from wildfires has not been studied. The objective of this study was to conduct a cost-utility analysis comparing screening followed by treatment with paroxetine or trauma-focused cognitive behavioral therapy (TF-CBT) versus no screening in Canadian adult wildfire evacuees. Methods. Using a Markov model, quality-adjusted life-years (QALYs) and costs were evaluated over a 5-y time horizon using health care and societal perspectives. All costs and utilities in the model were discounted at 1.5%. Probabilistic and deterministic sensitivity analyses examined the uncertainty in the incremental net monetary benefit (INMB) under a willingness-to-pay threshold of $50,000. Results. From a societal perspective, no screening (NMB = $177,641) was dominated by screening followed by treatment with paroxetine (NMB = $180,733) and TF-CBT (NMB = $181,787), with TF-CBT having the highest likelihood of being cost-effective at a willingness-to-pay threshold of $50,000 per QALY (probability = 0.649). The initial prevalence of PTSD, probability of acceptance of treatment, and costs of productivity had the largest impact on the INMB of both paroxetine or TF-CBT versus no screening. Neither intervention was cost-effective at a willingness-to-pay threshold of $50,000 per QALY from a health care perspective. Interpretation. Screening followed by treatment with paroxetine or TF-CBT compared with no screening was found to be cost-saving while providing additional QALYs in wildfire evacuees. Governments should consider funding screening programs for PTSD followed by treatment with TF-CBT for wildfire evacuees. Highlights Two prior studies examined the cost-effectiveness of screening followed by treatment for PTSD among individuals exposed to other disaster-type events (i.e., terrorist attack and Hurricane Sandy) and found screening followed by treatment (i.e., cognitive behavioral therapy [CBT]) to be highly cost-effective. Among wildfire evacuees, screening followed by treatment with paroxetine or trauma-focused (TF)–CBT provides additional quality-adjusted life-years (QALYs) and is cost-saving from a societal perspective. TF-CBT was the treatment option found most likely to be cost-effective. Neither treatment option was cost-effective at a willingness-to-pay threshold of $50,000 per QALY from a health care perspective. Screening programs for PTSD should be considered for wildfire evacuees, and individuals diagnosed with PTSD could be prescribed either TF-CBT or paroxetine depending on their preference and resources availability.
Reference36 articles.
1. Global heat stress on health, wildfires, and agricultural crops under different levels of climate warming
2. CBC Radio. 2 months after Lytton, B.C., was destroyed by fire, its future is still unclear. 2021. Available from: https://www.cbc.ca/radio/thecurrent/the-current-for-sept-7-2021-1.6166608/2-months-after-lytton-b-c-was-destroyed-by-fire-its-future-is-still-unclear-1.6171191
3. The Impact of Wildfires on Mental Health: A Scoping Review